The Relationship Between Tongue Pressure and Oral Dysphagia in Stroke Patients

Abstract

ObjectiveTo evaluate the relationships between tongue pressure and different aspects of the oral-phase swallowing function.MethodsWe included 96 stroke patients with dysphagia, ranging in age from 40 to 88 years (mean, 63.7 years). Measurements of tongue pressure were obtained with the Iowa Oral Performance Instrument, a device with established normative data. Three trials of maximum performance were performed for lip closure pressure (LP), anterior hard palate-to-tongue pressure (AP), and posterior hard palate-to-tongue pressure (PP); buccal-to-tongue pressures on both sides were also recorded (buccal-to-tongue pressure, on the weak side [BW]; buccal-to-tongue pressure, on the healthy side [BH]). The average pressure in each result was compared between the groups. Clinical evaluation of the swallowing function was performed with a videofluoroscopic swallowing study.ResultsThe average maximum AP and PP values in the intact LC group were significantly higher than those in the inadequate lip closure group (AP, p=0.003; PP, p<0.001). AP and PP showed significant relationships with bolus formation (BF), mastication, premature bolus loss (PBL), tongue to palate contact (TP), and oral transit time (OTT). Furthermore, LP, BW, and BH values were significantly higher in the groups with intact mastication, without PBL and intact TP.ConclusionThese findings indicate that the tongue pressure appears to be closely related to the oral-phase swallowing function in post-stroke patients, especially BF, mastication, PBL, TP and OTT.

Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double‐blind, randomized controlled trial

“…Previous studies have reported that tongue strength in patients with dysphagia after stroke has a relationship with the oral phase, particularly with regard to bolus formation, mastication, premature bolus loss, tongue to palate contact and oral transit time (Lee et al . , Oh et al . ).…”

“…, Lee et al . ). In addition, weakening of the suprahyoid muscles directly affects hyolaryngeal movements causing pharyngeal dysphagia, which can lead to pharyngeal residue and aspiration (Logemann et al .…”

Fatores associados à pressão de língua em pacientes pós-acidente vascular cerebral

“…Thus, the decrease in tongue pressure observed in some cases of stroke was basically associated with the presence of dysphagia. Several studies in the literature have related the decrease in tongue pressure to the symptom of dysphagia (10,20,21,22,23,24) . The results of this study indicated that tongue pressure in the subjects affected with stroke could trigger dysphagia.…”

“…Although impairment of this complex central system contributes to a decrease in the swallowing function, the restoration of this process after the stroke may also depend in part on the recovery of neuromuscular morphological factors, such as the strength of the intrinsic and extrinsic musculature of the tongue (9) . Abnormal tongue function may also favor the presence of oral residue, prolonged oral transit time (3) , difficulty in bolus formation, and premature loss of food (10) . There is evidence that the greatest degree of tongue strength impairment occurs in patients with oropharyngeal dysphagia, compared with those with adequate swallowing (6,8,11) .…”

Differential impact of tongue exercise on intrinsic lingual muscles

“…Healthy swallowing function is critical for airway safety, nutrition, and quality of life, yet aged individuals frequently develop difficulty swallowing, with dysphagia occurring in 15% to 40% of individuals over age 60 years . Tongue weakness, associated with both old age and dysphagia, has been identified as a therapeutic target. Tongue strengthening exercises increase maximum isometric tongue pressures and improve patient‐reported measures of swallowing .…”